did this patient do wrong?
(Published in Murfreesboro Post April 2010)
new patient sat in my office a few weeks ago. He was in obvious discomfort as he waited. He related
that he had been having back pain for over a month. It started after working in the yard when the first warm
weather appeared. He had felt some pain beginning in his back, but he had lived through back pain before so he
ignored it and pressed on. He had a lot of yard work to do and he was tough.
As the day progressed, the pain
subsided for a while, and then returned. He felt his back muscles tightening up and he was having a hard time
straightening up. His wife had some muscle relaxers left over from four years previously, so he opted to take
those. He also took extra strength Tylenol.
He continued working on the project until he “got
to a quitting point”. He went inside to lie on the floor. After an hour, he found that it
was very difficult to get up. He managed to get to the shower and felt a little better from the warm water.
He then wrapped a heating pad around his back and sat in his recliner and opened a cold beer. After three
more beers and two hours with the heating pad, he went to bed.
He awoke several times during the night.
He took the rest of his wife’s left-over medication. The next morning he could barely get out of
bed and he could not straighten up. It was Sunday, so he took it easy for the rest of the day. He
went to work on Monday after taking two doses of the Tylenol. He took a double dose at lunch and again when he
got home. He continued this way for four more weeks. He had some relief at times, but no improvement.
the time I met him he was having back pain constantly. He could not stand straight. He had gone
to a walk-in clinic and the nurse-practitioner had prescribed more muscle relaxers and prescription pain medication.
He told me that helped some but the pain came back when the drugs wore off.
Most people will experience disabling
lower back pain at some point in their life. By disabling, I don’t mean that you will never recover, but
rather that you will be dis-abled from doing your normal activities for a time.
I have treated thousands of patients
with spinal problems. Each patient is unique. You may have the exact same symptoms as your neighbor,
but the cause for the pain may be entirely different. This is important to understand. This means
that the recommendations that you see in any magazine or internet article (including this one) are generalized and will not
apply to all cases.
After you read the following recommendations, see how many things the patient did
you begin to feel back pain that is worsening, STOP what you are doing. Continuing the activity will likely worsen
your condition. By continuing to work with a worsening injury, the patient made sure he would not be able to
work in the yard again for weeks. Had he stopped and addressed the problem correctly, he may have been able to
resume his project the next day.
2. For most episodes of lower back and similar pain, application of COLD therapy will not only ease the pain,
but also help prevent swelling that can make recovery more difficult. Application of heat may feel good, but
can often make the inflammatory condition worse. It is often a good idea to apply a cold gel pack for fifteen
minutes, wait a half-hour, and then repeat.
3. “Movement GOOD – Strain BAD”.
When joint ligaments are swollen and muscles are in spasm, it may be helpful to GENTLY and SLOWLY move the affected
part through a nice, easy range-of-motion. Gentle movement can help preserve function and lessen the severity
of the painful muscle spasm. Don’t do any strenuous activity. For low back pain, gentle stretches
may be helpful.
Dr. Mark Kestner